Nightmare Disorder

Nightmare disorder, which is also called dream anxiety disorder, is characterized by the occurrence of repeated dreams during which the person feels threatened and frightened, causing the person to awake. To meet the criteria for nightmare disorder the person must wake fully and be aware of their surroundings. The nightmares must cause the patient distress in important areas of life, and the nightmares CANNOT be directly attributed to another disorder, or be the direct effects of medications, substance abuse, or a medical condition.

Nightmares are dreams that cause intense fear. These dreams are often complex and fairly long. During the dream, the sleeper usually encounters or experiences a threat to their life or safety. As the dream progresses, the threat to the person usually increases, as does their sense of fear. Waking usually occurs just as the threat or danger reaches its climax. It is often difficult for a person to return to sleep after waking from a nightmare. Nightmares usually occur during the second half of the night's sleep.

Waking is complete, and usually accompanied by increased heart rate, sweating, and other symptoms of anxiety or fear. Once fully awake, the person usually has a good recall of the dream and what was so frightening about it. Because of the physical symptoms of anxiety and because clarity is achieved immediately upon waking, returning to sleep after a nightmare is often difficult. The vividness of the recall and the prominence of the dream images in the person's mind can also make it difficult to calm down and return to sleep.

Sometimes people may avoid going to sleep after a particularly intense nightmare because of the fear of having another bad dream. In addition, people may have problems falling asleep if they are experiencing anxiety caused by the fear of having nightmares. As a result, these people may have the signs and symptoms associated with mild sleep deprivation, such as decreased mental clarity, problems paying attention, excessive daytime sleepiness, irritability, or mild depression.

The causes of nightmares are not known for certain. Adults who have nightmares on a regular basis are a small minority of the American population. About half of these people are thought to suffer from psychiatric disorders that cause the nightmares. Nightmares may also be triggered by major psychological traumas, such as those experienced by patients with Post-traumatic stress disorder. However, most people the nightmares are attributed to stress, and nightmares that occur on an irregular and occasional basis are usually attributed to life stressors and associated anxiety.

Some researchers think that artistic or creative people are at greater risk for nightmares, as are people who are generally sensitive. These people are considered to have well-developed imaginations and are very sensitive to environmental and social factors.

Nightmares can be a side effect of some medications or drugs of abuse, including drugs given for high blood pressure, levodopa and other drugs given to treat Parkinson's disease, amphetamines, cocaine, and other stimulants, some antidepressants, and withdrawal from alcohol and other medications.